As national emergency department demand has surged, Cincinnati Children’s — operator of the nation’s largest inpatient mental health hospital for children and adolescents — has taken a bundled approach to the pediatric behavioral health crisis.
The strategy spans integrated behavioral healthcare, school-based services and redesigned emergency department triage, Laurel Leslie, MD, director of the hospital’s mental and behavioral health institute, told Becker’s.
The system identified three levels of care for intervention: level 1 integrates behavioral health and primary care; level 2 expands intensive outpatient care and day programs; and level 3 redesigns emergency department intake and triage.
At level 1, the system prioritized embedding psychologists or master’s-level therapists in primary care offices and schools. MindPeace, a local nonprofit that partners with Cincinnati Children’s, works to broker relationships between outpatient mental health providers with schools through needs assessments.
“That means at the point of care where a problem is happening, somebody can see the child at that time,” Dr. Leslie said. “We know there’s a lot of stigma associated with seeing a mental health provider as well. So if they are seen in a setting that kids are already in, like primary care or schools, that makes a difference.”
Cincinnati Children’s also participates in Project ECHO, a telehealth-based education and case based management model aimed at strengthening behavioral healthcare across the community, Dr. Leslie said. She noted the system works with primary care physicians, school-based therapists and outpatient behavioral health providers to raise consistency around evidence-based care.
At level 2, the focus is on keeping children out of inpatient and residential settings by expanding higher-intensity outpatient and partial hospitalization programs. In some cases, therapists can be seen three to four times a week. Partial hospitalization allows for five to 10 school days of care, during which children can maintain academic responsibilities while receiving intensive therapy such as dialectical behavioral therapy.
The system also reduced ways to decrease barriers between physical and mental healthcare through data integration.
“We’ve found a way for outpatient mental health providers that are not in [Cincinnati] Children’s to be able to link into our EMR, and then they can track if kids have come into the emergency department, if they’ve been hospitalized, etc.,” Dr. Leslie said. “We can also see if they have openings available.”
To address emergency department strain — level 3 — the system created a psychiatric intake team for families and schools to call when a child is in crisis. The focus remains on providing therapeutic alternatives to the emergency department.
“Parents, primary care, doctors, therapists, schools can call [the line] and we will triage online with you,” Dr. Leslie said. “Does this child need to come into the ED? Can we reach out to the therapist they’re already seeing and get some immediate services for you? Or can we see you within the next 24 hours on an ill patient basis and assess it?”
